Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People

ABSTRACT. Objectives: This study examined the effects of testosterone treatment with or without chest reconstruction surgery (CRS) on mental health in female-to-male transgender people (FTMs). Methods: More than 200 FTMs completed a written survey including quantitative scales to measure symptoms of anxiety and depression, feelings of anger, and body dissatisfaction, as well as qualitative questions assessing shifts in sexuality after the initiation of testosterone. Fifty-seven percent of participants were taking testosterone and 40% had undergone CRS. Results: Cross-sectional analysis using a between-subjects multivariate analysis of variance showed that participants who were receiving testosterone endorsed fewer symptoms of anxiety and depression as well as less anger than the untreated group. Participants who had CRS in addition to testosterone reported less body dissatisfaction than both the testosterone-only or the untreated groups. Furthermore, participants who were injecting testosterone on a weekly basis showed significantly less anger compared with those injecting every other week. In qualitative reports, more than 50% of participants described increased sexual attraction to nontransgender men after taking testosterone. Conclusions: Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while CRS appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.     

Comparing Gender Expression,Gender Nonconformity,and Parents' Responses of Female-to-Male and Male-to-Female Transgender Youth

Abstract

Twenty-four female-to-male (FTM) and 31 male-to-female (MTF) transgender youth reported on their gender development and expression, and parental responses to their gender nonconformity. Both groups of youth felt different from others of their same birth sex at a mean age of seven and one-half years. The age when parents suggested they were different was younger for the MTF than the FTM youth. The MTF youth were called “sissy” at an earlier age than the FTM were called “tomboy.” Parents of FTM youth encouraged them to act in more traditional gender typical ways at a younger age than the MTF. The MTF youth considered themselves transgender two years earlier than the FTM youth. More parents of MTF youth felt that their children needed counseling than the parents of the FTM youth. While the majority of both groups reported past verbal victimization, comparatively more MTF youth reported being physically victimized. Implications of the developmental trajectories and experiences of transgender youth for school and family counselors are discussed.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Marital Status and Perceived Discrimination Among Transgender People

Despite calls for increased attention to the experiences of transgender people, scientific understanding of the stigma and discrimination this population experiences is limited. The authors integrate minority stress and marital advantage perspectives to assess marital status differences in transgender‐related perceived discrimination among transgender people in multiple life domains: the workplace, family, health care, and public accommodations. They analyze one of the first and most comprehensive large‐scale samples of transgender people in the United States (N = 4,286), the National Transgender Discrimination Survey. They find that married transgender respondents tend to report lower levels of perceived discrimination than their cohabiting and previously married transgender counterparts. Married transgender respondents do not, however, report lower levels of perceived discrimination than their never married counterparts, once all covariates are accounted for. These marital status differences appear primarily among transwomen but not transmen. Economic resources account for some, but not all, of these differences.     

Exploring the relationships among practitioners’ consultation skills,competence to counsel lesbian,gay, and bisexual clients,and attitudes toward transgender people

Abstract

Consultation is an intervention that can diffuse expertise in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) issues throughout systems of care. Practitioners (N?=?145) were surveyed on their lesbian, gay, and bisexual (LGB) counseling competence, attitudes toward transgender people, and consultation skills. Hierarchical multiple regression analysis identified that consultation competence significantly influenced (p?≤?.01) LGB counseling skills over and above LGB knowledge and awareness, attitudes toward transgender people, and participant demographic characteristics. The domains of LGB competence and attitudes toward transgender people were also significantly correlated within the participant sample. Implications for practice, training, and future research are discussed.     

College Health as a Partner in the Care of Pediatric Cancer Survivors

Abstract

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. Participants: Participants were University of Georgia (UGA) college health providers. Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.     

The Sexual Health of Transgender Men: A Scoping Review

There is a general paucity of research concerning the sexual health of transgender individuals, and most existing research focuses on transgender women. A scoping review concerning the sexual health of transgender men was conducted to identify gaps in the literature and to highlight opportunities for future research and intervention. A comprehensive search of seven databases was conducted. The Joanna Briggs Institute Reviewers’ Manual was used as a framework. Some 7,485 articles were initially identified using a search strategy applied to seven online databases: 54 articles were identified as relevant to the research questions and reviewed in detail; of those, 33 were included in the final analysis. Studies were conceptualized into four broad themes: sexual behaviors, sexual identity, sexual pleasure and sexual function, and transactional sex. Besides an overall lack of research, existing studies were often characterized by small convenience samples that do not allow for generalization to the larger population of transgender men. Significant gaps in the literature regarding sexual coercion, sexual and intimate partner violence, and relationship quality and functioning among transgender men exist. There is a need to improve the scope and depth of research examining the sexual health of this population, especially concerning sexual risk behaviors and structural barriers to sexual health care access.     

Cross-cultural Child Development for Social Workers: An Introduction

Abstract

The transgender community represents a highly marginalised portion of the Australian population, frequently experiencing discrimination, social isolation, and harm. This review explores literature informing Australian social work with transgender people. It highlights the importance of generating a transgender-positive discourse within Australian social work to effectively engage with and advocate for individuals with nontraditional gender identities. Key themes emerged from reviewing the literature related to the medical model, the mental health of transgender people, interdisciplinary and alternative transgender literature, minority status of transgender people, existing social work approaches to transgenderism, and Indigenous transgender literature. The views of transgender Australians are largely absent from the literature. However, the Australian transgender community's emerging voice and political activism highlights the potential for collaboration to play a significant role in the process of building a working knowledge base for social work. Based on the identified gaps in literature, in this paper we call for continued progress in developing a theoretical and practical knowledge base that incorporates the lived experiences of transgender Australians. We argue for the development of an approach to practice that is responsive to gender diversity. Highlighted in the review are the conditions that promote greater engagement with the transgender community.     

Awareness and attitude of medical personnel in Kerala,India to transgender persons

IntroductionBeing one of the first Indian states to come out with a transgender bill in 2015, Kerala's Social Justice Department also implemented various health-based provisions for transgender individuals catering to their physical, mental, and gender-based health. Many of these are still in the process of being set up and transgender individuals will have to wait for smoother access to healthcare.AimThis study aims to assess the awareness regarding general transgender issues and health as well as the attitude towards transgender persons among the medical community- especially medical students and doctors who are a critical link for the integration of the transgender community into society.MethodResponses were collected from 452 medical doctors and students from Kerala through scales that measured awareness level and attitude, including transphobia. The relation of gender, age, years of experience, and specialty of medical personnel to the level of transphobia and awareness about transgender issues was also analyzed using statistical methods.Result and DiscussionTransphobia levels were moderate in the sample. Women and medical students had lower levels of transphobia than men and practicing doctors respectively. Awareness levels were average for general information about the transgender community, such as its core features and difference from other similar categories but were low on health-related aspects of transgender persons (such as their physical and mental health issues, healthcare provisions, and knowledge on gender affirmation surgery).ConclusionMore inclusive actions are needed in medical education, legislative actions, advocacy groups, and the formation of multidisciplinary surgical teams to further the cause of the transgender community.     

Racial and Ethnic Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender-Nonconforming People

Members of the transgender/gender-nonconforming (GNC) community experience higher rates of discrimination based on their gender compared to their cisgender counterparts. Similarly, people of color experience higher rates of discrimination than White people. This study examines the difference in experiences of discrimination among transgender/GNC individuals in accessing social services providers by race/ethnicity (White and people of color). The data collected in a national cross-sectional survey (N = 6,451) and analyzed via chi-square test of independence and binary logistic regression demonstrate the disproportionate prevalence of discrimination based on race/ethnicity within the transgender/GNC population when accessing social services such as drug treatment centers, mental health clinics, domestic violence shelters, and rape crisis centers. Social workers are the most common provider of social services to the community, and have an ethical commitment to provision of services without discrimination. High rates of discrimination in accessing social services among transgender/GNC people, with even higher rates of discrimination for transgender/GNC people of color, highlight the need for improvement in social work education and practice.     

Transformations of Transgender

Abstract

Transgender males, called kathoey in Thai, are an ancient and widespread phenomenon in Asia and especially Southeast Asia. In this paper I consider Thai transgender males from a more contemporary perspective, focusing on changes in the definition and presentation of kathoey in the last two decades. These changes are related to alterations of the sex scene in western countries, the application of new medical technologies, and the development in Thailand of a new kathoey” c a -reer.” I base my study on in-depth interviews conducted in Thailand and the Netherlands. I discuss the inadequacy of conceptualizing ka-thoey as a category of homosexuals, arguing that kathoey first and foremost have to be seen as women. From this perspective, kathoey s' relationships with the partners they prefer become more understandable. I also interpret kathoeys' preference for farang(Caucasian) partners, the meanings they ascribe to having a sex-change operation, and their sexual behaviour from the perspective of considering them as women. I conclude with recommendations for social service work among kathoey and a reflection on the theory of sexual and erotic excitement.     

College students' acceptance of trans women and trans men in gendered spaces: The role of physical appearance

ABSTRACT

Transgender people often face prejudice and discrimination in school, employment, housing, and health care, and this can affect their psychological well-being. Although the literature on prejudice toward transgender people is growing, there is limited research that has examined differences in attitudes toward trans women and trans men separately. Specifically, the current study examined the role of physical appearance in the acceptance of transgender women and men in gendered spaces, including bathrooms, locker rooms, residence halls, and sorority and fraternity organizations. Participants viewed masculine-appearing and feminine-appearing images of a trans woman and trans man. Measurements of overall transacceptance and gendered-space acceptance were assessed. Results indicated that, in general, trans women were less accepted than trans men. The masculine-appearing trans woman was less accepted in the gendered spaces compared to the feminine-appearing trans woman and both images of the trans men. Also, female participants were generally more accepting of transgender people than male participants were. These findings suggest that, compared to trans men, discrimination of trans women is more likely, especially when the trans woman's physical appearance transgresses traditional gender expectations.     

Prevalence and risk and protective factors associated with HIV-related behavior among transgender people in Hong Kong

Abstract

This paper presents findings from the first large-scale quantitative study into HIV-related behavior among transgender people in Hong Kong. A survey of 195 transgender people found that only one-third of those who had engaged in sexual behavior in the past 3?months reported consistent condom use. Stable relationships, beliefs in low HIV transmission risk, and condom inaccessibility were cited as reasons for inconsistent condom use. The HIV testing figures were also strikingly low. This study demonstrates an urgent need for addressing HIV issues among transgender people in Hong Kong as there are currently no such specific services.     

Prevalence and Predictors of Disclosure of Transgender Identity

Abstract

The purpose of this study was to examine the prevalence and predictors of transgender identity disclosure in a gender minority sample. Participants (n = 156) were recruited from a New England transgender conference, and most (81%) reported male gender assignment at birth. Significant predictors of disclosure included age, transgender group, amount of time dressing as the identified gender, and involvement in the transgender community. The majority of participants indicated that they had disclosed to spouses and friends, followed by siblings and mothers. Individuals who disclosed to a greater number of people reported more social support than those who had disclosed to fewer people. Implications and limitations of this study are discussed.     

An exploratory study examining needs,access, and competent social services for the transgender community in Phoenix,Arizona

ABSTRACT

Phoenix is the sixth largest city in the United States, with a vibrant yet underserved lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Despite an extensive community presence, social service delivery bias persists among members of the LGBTQ community, but more often among transgender individuals. Existing research has examined social services from the perspective of either the client or the practitioner. This exploratory study specifically examines social services in the Phoenix metropolitan area for the transgender community. Data collected from interviews with participants and providers contributed to an assessment of the current level of social services for the transgender community, with a specific emphasis on identifying service gaps and recommendations for culturally competent and comprehensive services.     

Recognizing Abuse and Neglect in People with Severe Cognitive and/or Communication Impairments

ABSTRACT

It is widely acknowledged that physical abuse of persons with severe developmental disabilities is prevalent, usually perpetrated by a residential care provider and is rarely reported. However, no solid research on the topic has been reported. This article notes the lack of information about protective services directed to the developmentally disabled population and lack of coordination between agencies serving people with developmental disabilities and those providing protective services. The signs and symptoms of abuse in the developmentally disabled population, the alternative communication strategies required when interviewing, and the special skills needed for case assessment are presented. The author ends with a series of federal, state, and community level policy recommendations.     

Sexual Health in the Netherlands: Main Results of a Population Survey Among Dutch Adults

ABSTRACT

In 2006, the Rutgers Nisso Groep conducted an extensive population survey to assess the epidemiology of sexual health in the Netherlands. The sample consists of a random selection of the adult population living in the Netherlands (N= 4147) who were approached through internet panels. The study assesses the prevalence of a broad range of sexual health issues, including sexual and relational satisfaction, experience of sexuality, sexual identity, paraphilia, excessive desire, sexual dysfunctions, contraception, abortion, infertility, testing for sexually transmitted infections and HIV, condom use, and sexual violence. The data show, among other findings, that a small half of the adult Dutch population was basically without sexual health-related problems or stress during the year preceding the study. The other half experienced problems to a varying extent in one or more areas. Overall, 24% of the women and 19% of the men have experienced a need for professional sexual health care during the previous year. For women and men alike, relational problems are the most common complaint. About half of those in need of one or another form of sexual health care actually received it. Young people and people with an ethnic minority background show an elevated need for sexual health care.     

Urban college student self-report of hookah use with health care providers

Objective: This study's purpose was to describe urban college students’ communication about hookah with health care providers. Participants: Participants included a random sample of undergraduate urban college students and health care providers. Methods: Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. Results: Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. Conclusion: Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.